Cancer Res Treat.  2012 Mar;44(1):69-72.

A Case of Non-Hodgkin's Lymphoma in Patient with Coombs' Negative Hemolytic Anemia and Idiopathic Thrombocytopenic Purpura

• Park SY
• Kim S
• Kim ES
• Choi SU
• Hyun HJ
• Ahn JY
• Lee JH
• Ryu SH
• Park JH
• Lee GI
• Lee HJ

Abstract

Coombs' negative autoimmune hemolytic anemia (AIHA) is a rare disease which shares similar clinical and hematological features with Coombs' positive AIHA, but its exact frequency remains unknown. There have been few reports of idiopathic thrombocytopenic purpura (ITP) and Coombs' negative AIHA associated with other lymphoproliferative disorders (LPDs). Since there is a well known association between LPDs and autoimmune phenomena, it is important to investigate the possibility of an underlying malignancy. We report a case of ITP and Coombs' negative AIHA associated with diffuse large B-cell lymphoma.

Keyword

Lymphoma; Hemolytic anemia; Coombs' test; Idiopathic thrombocytopenic purpura

MeSH Terms

Anemia, Hemolytic
Anemia, Hemolytic, Autoimmune
Coombs Test
Humans
Lymphoma
Lymphoma, B-Cell
Lymphoma, Non-Hodgkin
Lymphoproliferative Disorders
Purpura, Thrombocytopenic, Idiopathic
Rare Diseases

Figure

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  Fig. 1 Bone marrow aspiration showed normocellular marrow with increased immature megakaryocyte (H&E staining, ×200).

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  Fig. 2 (A) Peripheral blood smear revealed macrocytic normochromic anemia (H&E staining, ×1,000). (B) Bone marrow biopsy shows normocellular marrow with increased erythroid and megakaryopoiesis (H&E staining, ×400).

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  Fig. 3 F-18 FDG PET/CT showed no significant uptage at the time of diagnosis of initial Coombs' negative hemolytic anemia (A) and multiple lymph node uptake of diffuse large B-cell lymphoma in right mediastinum (SUVmax=4.7), hila (SUVmax=4.2), and neck (SUVmax=5.2) (B)

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  Fig. 4 (A) Lymph node biopsy from right neck shows diffuse proliferation of medium-to-large atypical lymphoid cells with abundant cytoplasm and prominent nucleoli (H&E staining, ×400). (B) Diffuse CD20 positivity (CD20 immunohistochemical staining, ×400).

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